Serotonin toxicity

Serotonin Toxicity (also known as Serotonin Syndrome) is a potentially life-threatening condition resulting from an excess of serotonin in the central nervous system. It is most commonly triggered by the use of serotonergic drugs or substances, either alone or in combination, that increase serotonin levels or activity. Recognizing the signs and symptoms of serotonin toxicity is crucial for preventing severe complications or death.

Causes

Serotonin toxicity can occur when a person takes medications or substances that cause high levels of serotonin to accumulate in the body. This can happen through several mechanisms, including increased serotonin production, reduced serotonin breakdown, or enhanced serotonin receptor activity. Common culprits include Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), Monoamine Oxidase Inhibitors (MAOIs), and recreational drugs such as MDMA (ecstasy) and LSD.

Symptoms

The symptoms of serotonin toxicity can range from mild to severe and are often described by the Hunter Serotonin Toxicity Criteria, which include:

• Cognitive effects: confusion, hypomania, hallucinations, agitation, headache, coma.
• Autonomic effects: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea.
• Somatic effects: myoclonus (muscle twitching), hyperreflexia (exaggerated reflexes), tremor, incoordination, rigidity.

Diagnosis

Diagnosis of serotonin toxicity primarily involves a clinical assessment based on the patient's symptoms and medical history, particularly recent use of serotonergic drugs. Laboratory tests may be conducted to rule out other conditions with similar presentations, such as neuroleptic malignant syndrome.

Treatment

The treatment for serotonin toxicity typically involves discontinuing the serotonergic agents and providing supportive care to manage symptoms. In mild cases, this may be sufficient. For more severe cases, hospitalization may be required, and treatments may include sedation with benzodiazepines, administration of serotonin antagonists like cyproheptadine, and supportive measures to stabilize vital signs and prevent complications.

Prevention

Preventing serotonin toxicity involves careful management of serotonergic medications, including avoiding combinations of drugs known to increase serotonin levels. Patients should be educated about the potential risks of their medications and advised to seek immediate medical attention if symptoms of serotonin toxicity develop.

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